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Code Blue in The Hospital

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Gede Kevin Adhitya Saputra
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393 views26 pages

Code Blue in The Hospital

Uploaded by

Gede Kevin Adhitya Saputra
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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CODE BLUE IN THE HOSPITAL

WHAT TO DO WHEN IT’S CODE BLUE

Erwin*

•Anggota Bidang Pelayanan HIPERCCI Pusat,


• Komite Keperawatan RSJPDHK

Disampaikan dalam Workshop Early Warning System (EWS) HIPERCCI 2019 di Jakarta
RS JANTUNG DAN PEMBULUH DARAH
HARAPAN KITA
An emergency situation announced in a
hospital or institution in which a patient is
CODE BLUE
in cardiopulmonary arrest, requiring a
team of providers (sometimes called a
'code team') to rush to the specific
location and begin immediate
resuscitative efforts (Melissa Conrad
Stöppler, 2017).
KARS Dr.Nico Lumenta
Code Blue Team
Profesional
Code Blue Team
Dokter

Respiratory
Therapists
ED RN

Victim

CICU RN
pharmacist

PICU RN
come from multiple
locations throughout
the hospital
Code Blue Team
The key to running an
effective code blue is
the quality and timeliness
of the interventions.
Initiating a code blue
should be called immediately for any patient
who’s unresponsive, apneic, and/or pulseless.

American Heart Association (AHA) guidelines,


Calling for help and initiating CPR should be done
simultaneously

While awaiting members of the hospital-wide code team to arrive,


a nurse should initiate CPR and other interventions
( high quality CPR and rapid defibrillation )

Sinz E, Navarro K, Soderberg ES, eds. Advanced Cardiovascular Life Support: Provider Manual. Dallas,
TX: American Heart Association; 2011
Timeliness
Estimated time that after a code blue is called, 3
to 5 minutes may elapse before the code team
arrives at the bedside.
( Dynamics. 2010;21(3):22-24)

those minutes are critical to the patient’s


survival.
Copyright © American Heart Association, Inc. All rights reserved.
Copyright © American Heart Association, Inc. All rights reserved.
The Role of each member
Code Blue Team

• Compressor
• Airway manager
• Defibrillator manager
• Crash cart manager
• Code team leader
• The recorder documents
Compressor
2010 2015
Airway manager
1. Give the patient two ventilations for every 30 compressions using the bag-mask
device attached to an oxygen source.
2. Set the oxygen level on the flow meter at 15 L/min and, if applicable, fully open
the reservoir on the bag-mask device to ensure that each breath is delivered with
100% oxygen.
3. Bag-mask device ventilation is most effective when performed by two trained and
experienced providers. One provider opens the airway and seals the mask to the
face while the other squeezes the bag.
4. Make sure each compression of the bag causes the chest to rise. An oropharyngeal
airway can be placed to help ensure airway patency when delivering ventilations
with a bag-mask device.
5. During CPR, minimize interruptions in compressions when delivering ventilations.
6. Although ventilation with a bagmask device is acceptable during CPR, be prepared
to assist a qualified anesthesia provider with endotracheal intubation because
there are times when ventilation with a bagmask device is inadequate.

Sinz E, Navarro K, Soderberg ES, eds. Advanced Cardiovascular Life Support: Provider Manual. Dallas,
TX: American Heart Association; 2011
Defibrillator manager
Nurses should be trained in dysrhythmia
recognition and ACLS or have an expert to
help them identify dysrhythmias.

If no expert is immediately available, consider


using the AED, to ensure early defibrillation
when indicated before the code team arrives.
As soon as the shock is delivered
what should we do next ?
Recheck the rhythm or pulse ?

No !
Resume chest compressions immediately,
Even resumption of a normal heart rhythm
won’t initially produce enough cardiac output
for adequate perfusion
Safety guidelines for defibrillation
1. Know your monitor/defibrillator.
2. Know where the defibrillation cables and pads are kept.
3. Make sure defibrillator pads are fully in contact with the
patient’s bare chest.
4. The pad marked “sternum” should be below the right clavicle
in the midclavicular line (right anterior chest wall position).
5. The pad marked “apex” should be placed between the fourth
and fifth intercostal space on the left anterior axillary line
(left axillary position).
6. If necessary, pads may be placed anteriorly on the right side
of the patient’s sternum and posteriorly below the left
scapula and lateral to the spine.
Safety guidelines………………..

7. If the patient has an implanted pacemaker, position pads so that


they’re not directly over the device.
8. Ensure that oxygen flow isn’t directed across the patient’s chest.
9. Announce “Charging defibrillator to (specified number of joules)”
and press the defibrillator charge button.
10. When the defibrillator is fully charged, announce “I am going to
shock on three,” then count and announce “ALL CLEAR.” Chest
compressions should continue until this announcement is made.
11. After visually confirming all staff is clear of the patient and bed,
press the defibrillator shock button.
12. Immediately after the shock is delivered, resume CPR beginning
with compressions.
13. Make sure defibrillator supplies are restocked and the defibrillator
is plugged into the wall outlet for recharging after code is
complete.
Crash cart manager
• The crash cart contains emergency
medications and equipment, such as a
monitor/defibrillator or AED and airway
adjuncts.
• ACLS guidelines support early administration
of vasopressors in cardiac arrest, but
medications are secondary to high-quality CPR
and rapid defibrillation, when indicated
Miscommunication
is a common problem leading to
administration of incorrect
medications or doses during codes

Institute for Safe Medication Practices.Preventing medication errors


during codes. Nurse Advise-Err. 2011;9(9):1.
Code team leader
Taken by a physician or
An advanced care provider

Directs resuscitation efforts, communicates


with all team members, and monitors the
patient’s cardiac rhythm
The recorder documents
• Reminds the code team leader
every 2 minutes when it’s time for
a compressor role switch
• Record the time, name, and dose
of the last medication
administered.
• Document the cardiac rhythm
before a shock is delivered and
that compressions were
immediately resumed after the
shock.
• Notes that 100% oxygen is being
delivered and that the patient has
good rise and fall of the chest with
ventilations.
The recorder……………….

• Print cardiac rhythm strips or


the code summary from the
monitor/defibrillator for the
patient’s medical record.
• Clearly identify all
documentation with the
patient’s name, date of birth,
medical record number, and
date and time.
• Note the time that
resuscitation efforts were
discontinued, patient
disposition, and time of death
if applicable.
TEAM
WORK
TERIMAKASIH

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